What is the preoperative assessment for Transurethral Resection of Bladder Tumor (TURBT) procedures?

From the Guidelines

Preoperative assessment for Transurethral Resection of Bladder Tumor (TURBT) procedures should prioritize a thorough medical history, physical examination, laboratory tests, and imaging studies, with a focus on minimizing surgical complications and optimizing outcomes, and according to the most recent evidence, prophylactic antibiotics may not be necessary for all patients undergoing TURBT, except for those with high risk of postoperative sepsis 1.

Key Components of Preoperative Assessment

• Complete medical history focusing on urinary symptoms, hematuria, previous urological procedures, and comorbidities that may affect surgical risk
• Physical examination including abdominal, genital, and digital rectal examination
• Essential laboratory tests: complete blood count, coagulation profile, renal function tests, urinalysis, and urine culture
• Imaging studies: ultrasound of the kidneys and bladder, and CT urography if indicated

Management of Anticoagulants and Antibiotics

• Patients on anticoagulants should have their medication managed appropriately, with warfarin stopped 5 days before surgery, direct oral anticoagulants 48-72 hours before, and antiplatelet agents 7-10 days before, with bridging therapy using low molecular weight heparin if necessary
• Prophylactic antibiotics should be administered to patients with high risk of postoperative sepsis, as recommended by the European Association of Urology (EAU) guidelines 1

Anesthesia Evaluation and Patient Preparation

• Anesthesia evaluation should assess cardiopulmonary status and determine the appropriate anesthesia type (general or spinal)
• Patients should fast for at least 6 hours before surgery
• The use of antibiotic prophylaxis in TURBT procedures should be carefully considered, and reduced to a minimum without increasing postoperative complications, as suggested by the systematic review and meta-analysis published in The Journal of Urology 1

From the Research

Preoperative Assessment of TURBT Procedures

Overview of TURBT

• TURBT is a common urological procedure for bladder cancer diagnosis and treatment 2
• The procedure poses a significant risk of surgical complications, with bleeding and bladder perforation being the most common in-hospital complications 3

Patient-Related Factors

• Nicotine use, high ASA score, and presence of high-grade tumor are significant predictors of high-grade complications 3
• Male gender, multiplicity, and tumor location at the bottom of the bladder are associated with residual disease on reTURBT 4
• A history of preoperative venous thromboembolism (VTE) predicts higher rates of complications, novel VTE events, and increased hospital length of stay and costs 5

Surgeon-Related Factors

• Surgeon's experience is crucial in reducing the rate of post-operative complications 4
• Technical difficulties resulting from patient's gender, tumor location, or number of tumors may be as important as oncological factors in deciding whether or not to perform a second-look resection 4

Tumor-Related Factors

• Tumor stage is the strongest predictor of bleeding 3
• Presence of muscle in the specimen is a significant predictor of bladder perforation 3
• Tumor location at the bottom of the bladder is a risk factor for not finding muscle at pathological analysis 4

Perioperative Management

• Perioperative management of antiplatelet therapies should be achieved according to recommended practices 6
• A history of preoperative VTE increases the risk of novel VTE events following TURBT, highlighting the need for careful perioperative management 5